Referral details

Case 98651

Referral category

Region of interest

Referral reason

Canaray 98651

Volume rendering of tooth 23

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Impacted tooth 23

Tooth 23 is mesioangularly impacted in the anterior left maxilla. The crown of tooth 23 is located immediately palatal to the roots of teeth 21 and 22. This impacted tooth has caused mild external resorption of the palatal aspect of the apical third of the root of tooth 22. The root apex of tooth 23 is located at the junction of the anterior floor of the maxillary sinus and the lateral wall of the nasal fossa. The periodontal ligament space is not completely visualized around the root circumference of this impacted tooth, which suggests the possibility of ankylosis. The apical third of the root of tooth 23 is dilacerated in a superior direction. The residual follicle surrounding the crown of tooth 23 appears hypoplastic. The crown of this impacted tooth can be surgically accessed from the palatal aspect of the alveolar process, between the roots of teeth 21 and 22.

There is a large collection of radiopacities present in the anterior left maxilla, which appear to be bounded by the roots of teeth 22, 23, and 24. These radiopacities demonstrate an appearance similar to tooth structure, with an outer shell of enamel attenuation surrounded by an internal region with a density comparable to dentin. These small teeth-like structures (denticles) appear to be surrounded by a periodontal ligament space and lamina dura. These denticles have caused mesial and distal displacement of the roots of teeth 22 and 24, respectively, and are likely the cause of impaction of tooth 23. The adjacent buccal and palatal surfaces of the alveolar process also appear slightly expanded by these denticles. These findings are consistent with a large compound odontoma in the anterior left maxilla, and surgical excision is curative.

Axial views of the anterior left maxilla

These axial cross-sectional images demonstrate the presence of a large compound odontoma in the anterior left maxilla, which is located mesial to tooth 24, distal to tooth 22, and inferior to the impacted tooth 23. The buccal and palatal surfaces of the alveolar process appear slightly expanded in this region.

Normal tooth 21

Tooth 21 appears normal radiographically. There is no evidence of displacement or root resorption in association with its close proximity to the impacted tooth 23. The incisal aspect of the crown of tooth 23 is located immediately palatal to the apical half of the root of tooth 21.

Mild external root resorption on tooth 22P

There is mild external resorption located along the palatal aspect of the apical half of the root of tooth 22 due to its close proximity to the impacted tooth 23. The cervical aspect of the crown of tooth 23 is located immediately palatal to the apical half of the root of tooth 22.

Displaced tooth 22

The root apex of tooth 22 has been displaced in a mesiobuccal direction due to its close proximity to the impacted tooth 23 and the compound odontoma. The odontoma is located immediately distal to the root of tooth 22.

2. Periradicular bone loss on tooth 22

There is periradicular bone loss located along the distal surface of the apical half of the root of tooth 22. The buccal cortex appears dehiscent in this region, which suggests the presence of a draining sinus tract. There are no radiographic signs of a displaced root fracture. These findings suggest the possibility of rarefying osteitis in association with a devitalized tooth 22, which may be draining through a lateral canal. Clinical vitality testing of this tooth is recommended.

Axial views of tooth 22

These axial cross-sectional images demonstrate the presence of a single, centrally-positioned root canal system in tooth 22.

Buccolingual views of tooth 22

These buccolingual cross-sectional images demonstrate the partially dehiscent buccal cortex adjacent to the distal aspect of the root of tooth 22, suggesting the presence of a draining sinus tract. The palatal cortex adjacent to tooth 22 appears intact.

Mesiodistal views of tooth 22

These mesiodistal cross-sectional images demonstrate the presence of periradicular bone loss located along the distal aspect of the apical half of the root of tooth 22. This could have arisen from pulpal inflammatory disease that is draining through a lateral canal, or a non-displaced fracture plane that is not yet visible on CBCT imaging.

Displaced tooth 24

The root apex of tooth 24 has been displaced in a distal direction due to its close proximity to the compound odontoma. There is no evidence of root resorption in tooth 24. The root apex of tooth 23 is located apical and slightly mesial to the root apex of tooth 24. The compound odontoma is located immediately mesial to the root of tooth 24.

Axial views of the anterior left maxilla

These axial cross-sectional images demonstrate the palatal positioning of the crown of tooth 23 relative to the roots of teeth 21 and 22. The cusp tip of tooth 23 is located immediately lateral to the nasopalatine canal.

3. Palatal exostosis

An exostosis comprised of cortical and trabecular bone is present at the palatal aspect of the alveolar process adjacent to tooth 27. This exostosis represents an incidental finding and does not require intervention.

4. Mild mucositis of left maxillary sinus

The left maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.